Public vs Private Healthcare in Spain

Spain's public healthcare system is called the Sistema Nacional de Salud (SNS). It is funded through social security contributions and taxes. Access is primarily through employment or residency that includes social security coverage.

Workers contributing to Spanish social security are enrolled automatically. Their dependents are also covered. Retirees receiving Spanish pensions have access. Some residency permits include public healthcare; others do not.

Once enrolled, public healthcare is free at the point of service. There are no copays for doctor visits, hospital stays, or most treatments. Prescription medications have subsidized costs, with the percentage depending on income and age.

Employed workers paying into social security have full access. This includes employees of Spanish companies and self-employed individuals (autónomos) who pay their own contributions.

Some visa categories do not include public healthcare. Non-lucrative visas, for example, explicitly require private insurance because they prohibit employment. Digital nomad visa holders working for foreign companies may not qualify either.

EU citizens with European Health Insurance Cards (EHIC) have temporary coverage for necessary care. Long-term residents from EU countries can transfer healthcare rights, though the process involves paperwork between countries.

Public healthcare is organized by region. Each autonomous community manages its own health service. Quality and waiting times vary by region and by specific hospital or health center.

Patients are assigned a primary care doctor (médico de cabecera) at their local health center. This doctor handles general care and referrals to specialists. Specialist appointments require referral from primary care in most cases.

Waiting times for specialists and non-urgent procedures can be long. Weeks to months is common depending on specialty and region. Emergency care is immediate. Primary care appointments are typically available within days.

Private healthcare in Spain operates through insurance companies and direct-pay services. Patients choose their doctors and hospitals from network providers. The private sector includes hospitals, clinics, and specialist practices.

Private insurance is purchased individually or through employers. Premiums vary by age, coverage level, and health status. Major insurers in Spain include Sanitas, Adeslas, Asisa, and DKV, among others.

Some people use private healthcare exclusively. Others maintain private insurance alongside public access for faster specialist appointments or specific doctors. For an overview of insurance categories, see insurance options expats use. The systems operate independently but some doctors work in both.

Most private health insurance in Spain uses a copay model. Monthly premiums are lower, but each visit or service has a small additional cost. Full-coverage policies with no copays cost more.

Coverage typically includes primary care, specialists, hospitalization, and diagnostics. Dental, mental health, and maternity coverage vary by policy. Some services may have annual limits or waiting periods before coverage begins.

Pre-existing conditions are handled differently than in some countries. Insurers may exclude them, impose waiting periods, or charge higher premiums. Age also affects pricing significantly, with costs rising for older applicants.

Waiting times are one of the main differences between systems. Private healthcare typically offers specialist appointments within days. Public healthcare waits can extend to weeks or months for non-urgent specialist care.

The difference is most notable for elective procedures and specialist consultations. Emergency care is prompt in both systems. Primary care appointments are relatively quick in public healthcare, though private may still be faster.

Regional variation affects public waiting times. Some autonomous communities have shorter waits than others. Urban areas may have more capacity but also more demand. Rural areas may have fewer specialists available.

Public healthcare has no direct cost once enrolled. The cost is embedded in social security contributions and taxes. For someone already paying into the system, additional healthcare costs are minimal beyond subsidized prescriptions.

Private insurance costs €50–200+ per month depending on age, coverage, and insurer. Copay policies sit at the lower end. Comprehensive coverage for older individuals costs more. Family policies multiply individual costs. Managing these payments across currencies is covered in payment and budgeting tools.

Direct-pay private care without insurance is also possible. Consultation fees, tests, and procedures are paid out of pocket. This works for occasional use but becomes expensive for ongoing care or hospitalization.

Public healthcare operates in Spanish and regional languages. English-speaking staff are not guaranteed, though larger hospitals in international areas may have some availability. Medical terminology adds complexity.

Private healthcare often markets English-speaking services, especially in expat-heavy areas. International clinics cater to foreign residents. However, not all private providers offer English, and availability varies by location.

Language considerations affect both understanding care and navigating systems. Appointment booking, prescription instructions, and discharge information all require comprehension. Translation services exist but are not universally available.

Using both public and private healthcare is common in Spain. Someone enrolled in public healthcare might maintain private insurance for faster specialist access or specific services not well covered publicly.

The combination offers flexibility. Public for routine care and emergencies where quality is high and cost is zero. Private for elective procedures, faster diagnostics, or specialists with long public waiting lists.

Visa requirements sometimes mandate private insurance even when public access exists. In these cases, maintaining both systems is not optional. The private policy satisfies visa requirements while public access provides additional coverage. See travel insurance vs private health insurance for clarity on what types of coverage meet visa requirements.